Furosemide - Indications, Mechanism Of Action, Pharmacology, Adverse Effects, And Contraindications

Furosemide is a loop diuretic medication used in the treatment of conditions with volume overload and edema.
Some common indications of furosemide include the following.
Treatment of ascites and edema in chronic liver disease.
Treatment of heart failure.
Treatment of hypertension, along with other anti-hypertensive medications.
Renal impairment, including nephrotic syndrome.
And in the treatment of hyperkalemia.
Furosemide promotes its diuretic effects by inhibiting the tubular reabsorption of sodium and chloride in the proximal and distal tubules, as well as in the thick ascending loop of Henle.
Here, furosemide competitively inhibits the sodium-potassium-chloride cotransporters expressed along these tubules in the nephron, preventing the transport of sodium ions from the luminal side into the basolateral side for reabsorption.
This inhibition results in increased excretion of water along with sodium, chloride, magnesium, calcium, hydrogen, and potassium ions.
Similar to other loop diuretics, furosemide decreases the excretion of uric acid from the kidneys, predisposing to gout.
Furosemide also exerts direct vasodilatory effects, which results in its therapeutic effectiveness in the treatment of acute pulmonary edema.
Furosemide can be administered both orally and intravenously.
The dose may vary according to the indication and its severity.
The metabolism of furosemide occurs mainly in the liver and the kidneys, and the majority is excreted via the kidneys.
Potential adverse effects of furosemide therapy include the following.
Gastro intestinal effects such as Hepatic encephalopathy in patients with cirrhosis, Pancreatitis, Jaundice, Increased liver enzyme levels, loss of appetite, Oral and gastric irritation, Cramping, Diarrhea or Constipation, and nausea and vomiting.
Systemic hypersensitivity reactions and vasculitis.
Neurological effects such as ototoxicity, vertigo, headache, dizziness, blurred vision, and paresthesia.
Hematological effects such as Aplastic anemia, thrombocytopenia, agranulocytosis, hemolytic anemia, and leukopenia.
Dermatologic Reactions such as Toxic epidermal necrolysis, Steven-Johnson syndrome, Erythema multiforme, urticaria, and photosensitivity.
Other side effects include acute kidney injury due to fluid loss, increased serum cholesterol and triglyceride levels, hyperglycemia, hyperuricemia, hypokalemia, and hypomagnesemia.
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